[28F] Experiencing severe postpartum symptoms including spinal pain, migraines, and incontinence

Patient Description

A 28-year-old female, 12 days postpartum, reports experiencing sharp, paralyzing pain shooting up her spine from the bottom to the top for the past 11 days. This pain occurs constantly and is not relieved by any measures. She also has numbness in her arms, described as tingling and pain between her shoulder blades when her arms go numb. Additionally, she has been experiencing throbbing migraines, primarily at the back of her head but affecting her entire head, with an intensity of 7 out of 10, for the past 11 days. These migraines are a new experience for her. She has noticed excessive bruising on her thighs, with about 10 bruises of different sizes and purplish color, which started appearing randomly about a week ago. She hasn't had any injuries that could explain these bruises. She is also experiencing urinary incontinence, where she leaks a large amount of urine if she doesn't go to the bathroom immediately when she feels the urge, and bowel incontinence, mostly mucus, for about 5 days. The mucus is clear or white, with no blood or unusual color. The patient had a blood transfusion due to low iron the day after childbirth and experienced a rash on her legs afterward, which has since resolved. She also experienced shortness of breath after the transfusion. She vapes nicotine products but does not use alcohol, tobacco, or recreational drugs otherwise. She has no pre-existing conditions or chronic illnesses and is not currently taking any medications except for Tylenol (500mg twice a day) for migraines. She recently stopped taking prenatal vitamins.

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your sharp, paralyzing spinal pain, arm numbness, and tingling:

Postpartum complications: Given that your symptoms started the day after childbirth, there could be a connection to postpartum changes. Hormonal shifts, physical strain from delivery, or even nerve compression during labor could contribute to these symptoms.
Spinal issues: Conditions like herniated discs or spinal stenosis can cause sharp, shooting pain and numbness. These conditions can be exacerbated by the physical strain of childbirth.
Nerve compression: Issues such as cervical radiculopathy or thoracic outlet syndrome can cause pain that radiates from the spine to the arms, along with numbness and tingling.

Causes of your migraines:

Postpartum hormonal changes: Hormonal fluctuations after childbirth can trigger migraines.
Stress and fatigue: The physical and emotional stress of childbirth and caring for a newborn can contribute to migraines.

Causes of your excessive bruising:

Blood disorders: Conditions like thrombocytopenia (low platelet count) or clotting disorders can cause easy bruising.
Post-transfusion effects: Sometimes, blood transfusions can lead to temporary changes in blood clotting factors.

Causes of your urinary and bowel incontinence:

Postpartum pelvic floor dysfunction: Childbirth can weaken the pelvic floor muscles, leading to urinary and bowel incontinence.
Nerve damage: Nerve damage during childbirth can also contribute to these symptoms.

Unifying diagnoses:

Postpartum complications: Many of your symptoms could be related to the physical and hormonal changes that occur after childbirth.
Nerve compression or spinal issues: These could explain the spinal pain, arm numbness, and possibly even the migraines.

What you can do

Sharp, paralyzing spinal pain and arm numbness:

See a doctor as soon as possible: These symptoms could indicate a serious condition like a herniated disc or nerve compression. Your doctor may recommend imaging tests like an MRI to diagnose the issue.
At home: Avoid activities that exacerbate the pain, and consider using a supportive pillow or mattress to help with spinal alignment.

Migraines:

Consult a healthcare provider: They can help determine the cause of your migraines and recommend appropriate treatments, which may include medications or lifestyle changes.
At home: Try to rest in a dark, quiet room, and use a cold compress on your forehead. Over-the-counter pain relievers like Tylenol can also help, but be cautious with the dosage.

Excessive bruising:

See a doctor: Easy bruising can be a sign of a blood disorder or other serious condition. Your doctor may order blood tests to check your platelet count and clotting factors.
At home: Avoid activities that could cause further bruising, and keep track of any new bruises that appear.

Urinary and bowel incontinence:

Consult a healthcare provider: They can evaluate your pelvic floor function and recommend treatments, which may include pelvic floor exercises, physical therapy, or medications.
At home: Practice pelvic floor exercises (Kegels) to strengthen the muscles, and consider using incontinence pads for added protection.

General advice:

Use MDandMe: Journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Given the severity of your symptoms and the possibility of serious underlying conditions, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Worsening pain or numbness: If your symptoms become more severe or start affecting your ability to move.
New or worsening bruising: If you notice new bruises appearing without any apparent cause.
Changes in consciousness: If you experience confusion, dizziness, or fainting.
Severe headaches: If your migraines become more intense or are accompanied by other symptoms like vision changes or difficulty speaking.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.